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Treatment for Dientamoeba fragilis: A Systematic Review and Meta-analysis.

Nadav Baharav^1,2, Michael Itzkovich³, Eli Schwartz^4,5

¹Infectious Diseases Unit, Sheba Medical Center, 2 Sheba Road, 5265601, Ramat-Gan, Israel. Nadav.Baharav@sheba.health.gov.il.

Infectious Diseases and Therapy

|April 1, 2026

Summary

Paromomycin and clioquinol show higher clinical and microbiological response rates than metronidazole for treating Dientamoeba fragilis infections. Further research is needed to correlate clinical outcomes with eradication.

Keywords:

Dientamoeba fragilis Diarrhea Metronidazole Paromomycin Therapy

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Area of Science:

Medical Parasitology
Infectious Diseases
Clinical Microbiology

Background:

Dientamoeba fragilis (D. fragilis) is frequently detected in patients with gastrointestinal symptoms.
While its pathogenicity is debated, D. fragilis infections are often treated, commonly with metronidazole, despite limited supporting evidence.
The efficacy of metronidazole for D. fragilis treatment remains uncertain.

Purpose of the Study:

To systematically review and meta-analyze studies comparing metronidazole with other regimens for D. fragilis treatment.
To evaluate the clinical and microbiological response rates of different D. fragilis treatment strategies.

Main Methods:

A systematic review and meta-analysis of comparative studies evaluating D. fragilis treatment regimens.
Inclusion criteria comprised studies reporting clinical and/or microbiological outcomes for D. fragilis diagnosed via stool microscopy and PCR.
Searches were conducted in PubMed, Cochrane Library, and Web of Science up to March 2025, with clinical response as the primary outcome.

Main Results:

Twelve comparative studies were included in the quantitative meta-analysis.
Paromomycin and clioquinol demonstrated significantly higher clinical response rates compared to metronidazole (OR 2.31 and 2.52, respectively, with no heterogeneity).
Paromomycin also showed significantly higher microbiological response rates (OR 3.94), with a trend favoring clioquinol over metronidazole.

Conclusions:

This meta-analysis suggests that paromomycin or clioquinol may be more effective than metronidazole for treating symptomatic D. fragilis infections.
The findings support considering paromomycin or clioquinol when treatment for D. fragilis is indicated.
Further research is necessary to correlate clinical efficacy with microbiological eradication rates.